medium-term post-katrina health sequelae son chae kim phd, rn quynh bui gredig msn, rn ruth l. plumb...
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Medium-Term Post-Katrina Medium-Term Post-Katrina Health SequelaeHealth Sequelae
Son Chae Kim PhD, RNSon Chae Kim PhD, RNQuynh Bui Gredig MSN, RNQuynh Bui Gredig MSN, RN
Ruth L. Plumb MSN, RN Ruth L. Plumb MSN, RN Larry Rankin PhD, RNLarry Rankin PhD, RN
Barbara Taylor PhD, RNBarbara Taylor PhD, RN
Pre-KatrinaPre-Katrina
High poverty levels: High poverty levels: 22ndnd worse state worse state
12% unemployment rate:12% unemployment rate: Twice national averageTwice national average
21% receive food stamps:21% receive food stamps: Three times national average (Three times national average (Louisiana Department Louisiana Department
of Health and Hospitals, 2005)of Health and Hospitals, 2005)
20% of Jefferson Parish eligible for Medicaid20% of Jefferson Parish eligible for Medicaid
Hurricane KatrinaHurricane Katrina
August 29, 2005August 29, 2005
The Christian Science Monitor, The Christian Science Monitor, http://www.csmonitor.com/slideshows/katrina2/slide3.html
Hurricane RitaHurricane Rita
September 24, 2005September 24, 2005
Wikimedia Commons, Wikimedia Commons, http://commons.wikimedia.org/wiki/Image:Hurricane_Rita_200509240900-3-Day_Cone.gif
Wikipedia, Wikipedia, http://en.wikipedia.org/wiki/Hurricane_Katrina
BackgroundBackgroundShort-term Post-KatrinaShort-term Post-Katrina
2 weeks post-Katrina: (Millin, et al. 2006)2 weeks post-Katrina: (Millin, et al. 2006) >40% clinic visits for chronic illness management>40% clinic visits for chronic illness management
4 -8 Months Post-Katrina: (Weisler, et al., 2006)4 -8 Months Post-Katrina: (Weisler, et al., 2006) Suicide rates Suicide rates ↑↑ X 3 X 3 Murder rates Murder rates ↑ ↑ 37% over pre-Katrina rates 37% over pre-Katrina rates
1 Year Post-Katrina: (Lambrew & Shalala, 2006)1 Year Post-Katrina: (Lambrew & Shalala, 2006) Many hospitals remained closed, including Charity Many hospitals remained closed, including Charity
hospitalhospital
PurposePurpose
To describe medium-term effects on living To describe medium-term effects on living environment, health status & healthcare environment, health status & healthcare accessaccess
To assess medium-term mental and physical To assess medium-term mental and physical health 15 months post-Katrinahealth 15 months post-Katrina
To determine demographic, social & To determine demographic, social & environmental factors that predict poor environmental factors that predict poor mental & physical healthmental & physical health
Method Method
Study Design: Cross sectional surveyStudy Design: Cross sectional survey Sampling: A convenience sample (Sampling: A convenience sample (NN=222) =222)
Inclusion Criteria: age 18yrs or older, currently Inclusion Criteria: age 18yrs or older, currently living or working in the area, able to speak and living or working in the area, able to speak and understand English.understand English.
Study Duration: December 16 -18, 2006Study Duration: December 16 -18, 2006
MethodMethod
Questionnaire: survey items were selected Questionnaire: survey items were selected Behavioral risk Factor Surveillance System Behavioral risk Factor Surveillance System
(BRFSS)(BRFSS) MMWR Morbidity and Mortality Weekly ReportMMWR Morbidity and Mortality Weekly Report United States Department of AgricultureUnited States Department of Agriculture Previous reports on disaster-related studiesPrevious reports on disaster-related studies
MethodMethod
Approved by PLNU IRBApproved by PLNU IRB Data collectionData collection
Data collector trainingData collector training 6 teams of faculty, MSN, & BSN students6 teams of faculty, MSN, & BSN students Door-to-door survey & Health FairDoor-to-door survey & Health Fair
Structured Interview ProcessStructured Interview Process
Data Analysis:Data Analysis: Descriptive StatisticsDescriptive Statistics Multivariate Logistic RegressionMultivariate Logistic Regression
Participants CharacteristicsParticipants CharacteristicsParticipants Characteristics (N=222)
0% 20% 40% 60% 80% 100%
35-64 y/o
Not Married
Black
Female
Post HS ed.
Unemployed
Descriptive StatisticsDescriptive Statistics
Living Environment 27% living below poverty line 15% difficulty accessing clean drinking water 26% eating less than they should due to lack
of money 23% feeling unsafe from crime
Descriptive StatisticsDescriptive Statistics
Healthcare AccessHealthcare Access
Sources of Health Care Service
0%10%20%30%
40%50%60%
Physician's Office Hospital or ER No Source ofHealthcare
Per
cen
t o
f R
esp
on
den
ts
Pre-Katrina
15 Moths Post-Katrina
Source of Health Care Coverage
0%10%20%30%40%50%
PrivateInsurance
GovernmentAid
No Source ofCoverage
Not Sure
Per
cen
t o
f R
esp
on
den
ts
Pre-Katrina
15 Months Post-Katrina
Healthcare StatusHealthcare Status
Mental and Physical Health Diagnoses (N=222)
DiagnosesPre-Katrina
n (%)Post-Katrina
n (%)Totaln (%)
Depression 18 (8) 29 (13) 47 (21)
Hypertension 88 (40) 10 (5) 98 (44)
Arthritis 55 (25) 5 (2) 60 (27)
Diabetes Mellitus 24 (11) 3 (1) 27 (12)
Angina 14 (6) 12 (5) 26 (12)
Asthma 22 (10) 2 (1) 24 (11)
Frequency of Poor Mental Frequency of Poor Mental Health DaysHealth Days
0%
10%
20%
30%
40%
50%
60%
0 1-7 8-14 15-21 22-29 30
No. of Poor Mental Health Days
% o
f R
es
po
nd
en
ts
Multivariate Logistic Regression Multivariate Logistic Regression Model Predicting ≥ 1 Day of Poor Model Predicting ≥ 1 Day of Poor
Mental Health Mental Health
Odds Ratio 95% CI p Pre-Katrina depression 19.1 2.1 – 172 0.009 Post-Katrina depression 7.2 1.8 – 29.0 0.005 ≥ 1 Day of poor physical health during the past month
5.6
2.7 – 11.0
< 0.001
Feel unsafe from crime 4.3 1.7 – 11.0 0.002 Female gender 2.6 1.3 – 5.3 0.009
Frequency of Poor Physical Frequency of Poor Physical Health DaysHealth Days
0%
10%
20%
30%
40%
50%
60%
0 1-7 8-14 15-21 22-29 30
No. of Poor Physical Health Days
% o
f R
es
po
nd
en
ts
Multivariate Logistic Regression Multivariate Logistic Regression Model Predicting ≥ 1 Day of Poor Model Predicting ≥ 1 Day of Poor
Physical Health (Physical Health (NN=198)=198)
Odds Ratio 95% CI p ≥ 1 Day of poor mental health during the past month
3.9
2.0 - 7.5
< 0.001
Lack of money for food 2.7 1.2 – 6.0 0.017 Pre-Katrina arthritis 2.6 1.2 – 5.7 0.019
ConclusionsConclusions
Fifteen months post-Katrina, the experience continues to affect the mental and physical health of New Orleans residents.
The rebuilding and reestablishment of basic needs and of accessible healthcare are continuing needs.
RecommendationsRecommendations
Ongoing community assessments to identify issues with healthcare access and health related needs.
Partnering of the public health system and local communities to identify program development opportunities and interventions.
ReferencesReferences
Brodie M, Weltzien E, Altman D, Blendon RJ & Benson JM (2006): Brodie M, Weltzien E, Altman D, Blendon RJ & Benson JM (2006): Experiences of hurricane Katrina evacuees in Houston shelters: Experiences of hurricane Katrina evacuees in Houston shelters: implications for future planning. implications for future planning. American Journal of Public HealthAmerican Journal of Public Health 9696, , 1402-1408.1402-1408.
Centers for Disease Control and Prevention (2006): Assessment of health-Centers for Disease Control and Prevention (2006): Assessment of health-related needs after Hurricanes Katrina and Rita--Orleans and Jefferson related needs after Hurricanes Katrina and Rita--Orleans and Jefferson Parishes, New Orleans area, Louisiana, October 17-22, 2005. Parishes, New Orleans area, Louisiana, October 17-22, 2005. MMWR MMWR Morbidity Mortality Weekly Report Morbidity Mortality Weekly Report 5555,, 38-41. 38-41.
Lambrew JM & Shalala DE (2006): Federal health policy response to Lambrew JM & Shalala DE (2006): Federal health policy response to Hurricane Katrina: what it was and what it could have been. Hurricane Katrina: what it was and what it could have been. Journal of the Journal of the American Medical AssociationAmerican Medical Association 296 296, 1394-1397., 1394-1397.
Louisiana Department of Health and Hospitals, Office of Public Health, Policy, Louisiana Department of Health and Hospitals, Office of Public Health, Policy, Planning, and Evaluation Section. (2005). Planning, and Evaluation Section. (2005). 2005 Parish health profiles: A 2005 Parish health profiles: A tool for community health planning.tool for community health planning. Retrieved May 14, 2007 from Retrieved May 14, 2007 from http://www.dhh.louisiana.gov/OPH/PHP%202005/Data/Jefferson/index.hthttp://www.dhh.louisiana.gov/OPH/PHP%202005/Data/Jefferson/index.htmm
ReferencesReferences
Millin MG, Jenkins JL & Kirsch T (2006): A comparative analysis of two Millin MG, Jenkins JL & Kirsch T (2006): A comparative analysis of two external health care disaster responses following Hurricane Katrina. external health care disaster responses following Hurricane Katrina. Prehospital Emergency CarePrehospital Emergency Care 1010, 451-456., 451-456.
Mills MA, Edmondson D & Park CL (2007): Trauma and stress response Mills MA, Edmondson D & Park CL (2007): Trauma and stress response among Hurricane Katrina evacuees. among Hurricane Katrina evacuees. American Journal of Public HealthAmerican Journal of Public Health 97 Suppl 197 Suppl 1, S116-123., S116-123.
Weisler RH, Barbee JGt & Townsend MH (2006): Mental health and Weisler RH, Barbee JGt & Townsend MH (2006): Mental health and recovery in the Gulf Coast after Hurricanes Katrina and Rita. recovery in the Gulf Coast after Hurricanes Katrina and Rita. Journal of Journal of the American Medical Association the American Medical Association 296296, 585-588., 585-588.
Walker, B. & Warren, R. (2007). Katrina perspectives. Walker, B. & Warren, R. (2007). Katrina perspectives. Journal of Health Journal of Health Care for the Poor and Underserved. Care for the Poor and Underserved. 18:233-240.18:233-240.